ES2303196T3 - SURGICAL STAPLING INSTRUMENT THAT INCORPORATES AN IRREGULAR ROTARY TRANSMISSION. - Google Patents

Abstract

A surgical stapling and severing instrument particularly suited to endoscopic procedures incorporates a handle that produces separate closing and firing motions to actuate an end effector. In particular, the handle produces multiple firing strokes in order to reduce the required amount of force required to fire (i.e., staple and sever) the end effector. Varying the center of rotation, circumferential length, and depth of cam lobes in a cam disk that interacts with the firing trigger via a drive wedge allows optimization. In particular, mechanical advantages during specific firing strokes mitigates increased force to fire at the end effector, enabling a more uniform tactile force at the firing trigger.

Description

Surgical stapling instrument that incorporates an irregular rotary transmission.

Field of the Invention

The present invention generally relates to field of surgical stapling instruments that are capable of apply staple lines on the tissue while cutting the tissue between those lines of staples and, more specifically, to certain instrument-related improvements and stapler improvements in procedures to constitute various components of said stapling instruments that perform shooting with multiple trigger operations.

Background of the invention

Endoscopic surgical instruments are a often preferred to open surgical devices traditional because a smaller incision tends to reduce the time and postoperative recovery complications. In Consequently, there has been considerable development in a series of endoscopic surgical instruments that result appropriate for a precise location of an end effector distal at a desired surgical site through a trocar cannula These distal terminal effectors lock the tissue in various ways to achieve a therapeutic effect or diagnosis (for example endocortador, prensor, cutter, staplers, clip applier, access device, device of therapy, pharmacological / gene, and device delivery energy that uses ultrasound, RF, laser, etc.).

Known surgical staplers include a terminal effector that simultaneously makes an incision longitudinally in the fabric and apply staple lines on the sides opposite of the incision. The terminal effector includes a pair of cooperating jaw members that, if the instrument is intended for endoscopic or laparoscopic applications, they are capable of passing through the opening of a cannula. One of the members Jaw includes a staple cartridge that has at least two rows of staples separated laterally. The other gag member defines an anvil that has cavities of conformation of the staples aligned with the rows of staples within the cartridge. The instrument includes a plurality of oscillating wedges which, when driven distally, go through the staple cartridge openings and lock actuators that support the clips to trigger the clips towards the anvil.

An example of an appropriate surgical stapler in Endoscopic applications are described in US Pat. No. 5,465,895, which advantageously provides some shares of independent closing and firing. Through this system, the optional can close the jaw members on the tissue to place the tissue before firing. Once the doctor has determined that the jaw members are properly grabbing tissue, the doctor can then fire the surgical stapler with a single firing operation, cutting and stapling the tissue in this way. Simultaneous cutting and stapling avoid complications that may occur when executing those actions sequentially with different surgical instruments that respectively only cut or staple.

A specific advantage of being able to close jaw members on the tissue before firing is that the optional is able to verify by means of an endoscope that has achieved a desired cutting position, comprising the capture a sufficient amount of tissue between the jaws opposite. Otherwise, opposite jaws can be placed. too close to each other, especially pinching at its ends distal, and not effectively forming the staples closed in The cut tissue. At the other extreme, an excessive amount of subject tissue can cause jamming and firing incomplete.

In general, a single closing operation followed by a single shot is a convenient and efficient way to carry out cutting and stapling. However, in some cases, it would be desirable, even required, to have multiple firing operations. For example, surgeons can select, from a range of jaw sizes, a corresponding length of staple cartridge to obtain the desired length of cut. Longer staple cartridges require a longer firing operation. Therefore, a hand-held trigger is required to make the shot to exert a greater force for these longer staple cartridges, in order to cut more tissue and operate more staples compared to a shorter staple cartridge. It would be desirable that the amount of force be less and comparable to that of shorter cartridges so as not to exceed the manual force of some surgeons. Likewise, some surgeons unfamiliar with large staple cartridges may feel worried when a blockage or other malfunction has occurred when unexpectedly more force is required.
high.

A proposal to reduce the required force of a firing operation is a ratchet mechanism that allows a trigger to be pressed several times, such as It is described in US Patent Nos. 5,762,256 and 6,330,965. However, it is believed that the conversion of the movement trigger trigger oscillation directly within a Solid zipper by means of a tongue constrain the options of design of a desired amount of firing motion during Each trigger operation. Also, these stapling instruments known surgical with multiple firing mechanisms operations do not have the advantage of a close and trip action separated.

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Consequently, there is a strong need for a surgical stapling instrument that uses multiple firing operations to achieve a desired cutting length and stapling with a desired displacement ratio of the trigger operation with respect to trigger movement longitudinal produced for a terminal effector, but more specifically, an instrument that maximizes strength and displacement of each operation.

Brief summary of the invention

In accordance with the present invention, provides a surgical stapling instrument according to what defined in claim 1 comprising:

an effector terminal functionally configured to respond to a movement firing;

an axis fixed to terminal effector and that includes an elongated firing member coupled to the terminal effector for its displacement to transmit longitudinally the firing movement; Y

a hilt fixed proximally to the axis comprising:

a member of cam that includes a plurality of cam lobes, differing in as to the shape of at least one of the cam lobes of a lobe adjacent cam,

an actuator of shot that can move repeatedly in a direction of trip and return address, and functionally configured to interact with a respective cam lobe during each shooting operation, and

a mechanism of shot that responds to the intermittent motion of the cam disc to produce the longitudinal firing motion on the executing portion.

Preferably the cam member comprises a cam disc that includes a plurality of cam lobes around at least a portion of a circle, differing in terms of at least one of the cam lobes of a lobe of adjacent cam.

Preferably the handle thus comprises same a wedge coupled to the trigger actuator and configured operatively to sequentially lock a respective lobe of the plurality of respective lobes of the cam disc during each trip actuator travel in the direction of Shooting.

Preferably the handle thus comprises same a zipper connected to the shaft trigger member and coupled by gear connection with cam disc for transmit an intermittent rotation of the cam disc as longitudinal firing movement.

Preferably the zipper is attached by gear connection with the cam disc composed with A train of gears.

Preferably the gear train comprises a demultiplication assembly that relates rotation intermittent cam disc with longitudinal movement increased zipper.

Preferably the surgical instrument it also comprises a configured anti-reverse mechanism operatively to prevent rack retraction between the trigger operations of the trigger actuator.

Preferably, the terminal effect comprises a pair of opposing jaws that respond to a closing movement and a firing bar that responds to the firing member, the axis operatively configured to transmit the movement of closing through a closing member to the terminal effector, the handle also comprising a closing mechanism operationally configured to produce the movement of closing.

Preferably the surgical instrument It also includes a trigger locking mechanism that responds  to a closing mechanism not closed to prevent displacement of the zipper.

Preferably the locking mechanism of trigger is operatively set to respond to the zipper that has been at least partially shot to block the opening movement of the closing mechanism.

Preferably the handle thus comprises same a locking lock that responds to the closing movement of the closing mechanism to block the closing mechanism.

Preferably the handle thus comprises same:

a mechanism of trigger lock that responds to the closing mechanism not closed to prevent the movement of the zipper and that responds to the zipper that has been partially fired to prevent opening of the closing mechanism;

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a mechanism of fastening lock that responds to the closing movement of the closing mechanism to block the closing mechanism;

a mechanism backstop set operationally to prevent retraction of the zipper between trigger trigger operations of Shooting; Y

a mechanism of release operatively configured to unlock the mechanism backstop.

Preferably the release mechanism is also operatively configured to unlock the mechanism of clamping of the subjection.

Preferably the terminal effector is Operationally configured to staple and cut tissue during Shooting.

Preferably the handle thus comprises same a pistol handle and the zipper comprises a zipper folding that can be put in the pistol handle when it is withdrawn

A surgical instrument is also disclosed that understands:

an effector terminal operatively configured to respond to a mechanism firing;

an axis fixed to terminal effector and that includes an elongated firing member coupled to the terminal effector for its displacement to transmit longitudinally the firing movement; Y

a hilt fixed proximally to the axis, which comprises:

a member of linear shot fixed proximally to lengthen the limb of shot located on the shaft,

an actuator of repeatedly removable firing in the firing direction and a return address that responds to the user's drive, Y

a member of Operationally placed lock for rotation in response to each travel direction of trigger actuator for coupling selectively the movement of the forward shot of the trigger actuator on the linear trigger member.

Preferably the blocking member comprises a tongue coupled to the trigger actuator and a mechanism of cam gear rotatably coupled to the handle and located Operationally to respond to the language.

Preferably the blocking member comprises a tongue, the linear firing member comprises a zipper located for gearing with the tongue during movement forward.

Preferably the linear trigger member It comprises an articulated zipper.

The invention resolves the deficiencies expressed and other shortcomings of the prior art providing a surgical stapling and cutting instrument that it has a rotary transmission that transfers a sequence of Multiple shooting operations. In particular, understanding that the terminal effector of said instrument requires different force levels during firing, a rotary transmission of a trigger mechanism varies the mechanical advantage during certain operations compared to others, maximizing the shot to obtain more uniform levels of force. This shape the grip does not require an excessive number of operations trigger simply to manage the number of operations of the worst case scenario in which the largest are required forces.

In another aspect of the invention, another surgical instrument has a terminal effector that responds to a longitudinal firing movement to carry out an operation surgical A user causes the movement in an actuator trigger to create the trigger movement that is selectively transferred by a firing motion. Specifically, a cam disc has a plurality of cam lobes around at least a portion of its circumference that are respectively locked by a traction wedge coupled to the trigger actuator when making a firing motion. The cam disc is attached to a rack using a gear connection to convert this intermittent rotational movement in the firing movement longitudinal. The moment arm and the radial separation of the Cam lobes are advantageously diversified to give response to the amount of force required during an operation respective. The increase of the mechanical advantage through a specific operation in which resistance is offered considerable in the terminal effector (for example, tissue cutting, firing pin friction, stapling) makes it possible to use a minimum number of multiple operations having each operation a similar sensitivity for the surgeon.

These and other objects and advantages of this invention will be revealed by the drawings that are Accompany and its description.

Brief description of the figures

The accompanying drawings, which are incorporate and constitute a part of this report descriptive, illustrate embodiments of the invention, and, together with the general description of the invention offered above, and with the detailed description of the ways of realization offered below, serve to explain the principles of the invention.

Fig. 1 is a perspective view of a surgical stapling and cutting instrument that has an effector open terminal

Fig. 2 is an elevation view of the side left in cross section along the lines 2-2 of the open terminal effector of Fig. 1.

Fig. 3 is a perspective view of the Open terminal effector of Fig. 1.

Fig. 4 is a perspective view, in neat cutting of an executing portion of the instrument surgical stapling and cutting of Fig. 1.

Fig. 5 is a perspective view, in exploded view of a handle of a surgical instrument of stapling and cutting of Fig. 1.

Fig. 6 is an elevation view of the side left of the grip of the surgical stapling instrument and cut of Fig. 1 in the open state with a left portion of the handle housing removed to expose a trigger mechanism that includes a rotary transmission for Perform multiple firing operations.

Fig. 7 is an elevation view of the side right of the handle of Fig. 6 with a right portion of the portion of the handle removed to expose a closing mechanism and anti-reverse features.

Fig. 8 is a perspective view towards below the handle of Fig. 7.

Fig. 9 is a side elevation view of the handle of Fig. 6 with the closing trigger closed and the trigger trigger omitted to expose a wedge of trigger drive and cam lobes located in a cam disc

Fig. 10 is a perspective view towards below the trigger drive wedge and the lobes of cam of Fig. 9.

Fig. 11 is a perspective view from behind a trigger mechanism of the rotary transmission of the handle of Fig. 1.

Fig. 12 is a side elevation view of the handle of Fig. 6 in closed state and fired with a small crazy gear drive trigger mechanism Rotary omitted to expose a pendulum backstop that contacts a solid zipper.

Fig. 13 is a side view of a disk of cam for a rotary transmission trigger mechanism that incorporates irregular firing operations to boost the maximum trigger forces of the trigger trigger for the surgical stapling and cutting instrument of Fig. 1.

Fig. 14 is an illustrative diagram of the firing force with respect to the trip offset for a multi-shot operation instrument that incorporates some uniform shooting operations.

Fig. 15 is an illustrative diagram of the firing force with respect to the trip offset for a multi-shot operation instrument that incorporates a irregular firing operation maximized with respect to the firing forces experienced in the trigger trigger.

Fig. 16 is a drawing of a zipper open that has a zipper teeth sections irregularly separated for a firing mechanism of linear transmission that incorporates firing operations irregular to maximize the firing forces in the trigger trigger of the surgical stapling and cutting instrument Fig. 1.

Fig. 17 is a drawing of a zipper articulated that incorporates sections of zipper teeth irregularly separated from a transmission trigger mechanism linear that incorporates irregular firing operations to maximize the trigger forces of the trigger trigger of the surgical stapling and cutting instrument of Fig. 1.

Fig. 18 is a drawing of a mechanism of linear shot of tapered rod with a bolt pull of counter door that incorporates a traction of the door closer which incorporates irregular firing operations to maximize firing forces on the trigger trigger in a surgical stapling and cutting instrument of Fig. 1.

Detailed description of the invention

Directing attention to the Drawings, in which the same numeric references indicate the same components to along the different views, Figs. 1 to 4 show a 10 stapling and cutting surgical instrument that is capable of carrying to practice the unique benefits of the present invention. He surgical stapling and cutting instrument 10 incorporates an effector terminal 12 having an anvil 14 pivotally attached to a elongated channel 16, forming opposite jaws to ignite the tissue that is going to be cast and stapled. The terminal effector 12 is coupled by an axis 18 to a handle 20. A portion executor 22 constituted by terminal effector 12 and axis 18 it is advantageously the precise size for insertion through  a trocar or a small laparoscopic opening to carry perform an endoscopic surgical procedure while being controlled by a surgeon who grabs the handle 20. The handle 20 advantageously includes features that enable separate movement of the terminal effector closure 12 regarding the shot, as well as the possibility of carrying out multiple firing operations to trigger (that is, cutting and stapling) of terminal effector 12 while indicating the degree of shot to the surgeon.

For these purposes, a closing tube 24 of the axis 18 is coupled between trigger 26 and anvil 14 to cause the closure of terminal effector 12. Inside the closure tube 24, a frame 28 is coupled between elongated channel 16 and the handle 20 to position longitudinally and support the effector terminal 12. A rotary handle 30 is coupled to the frame 28, and both elements are rotatably coupled to the handle  20 with respect to a rotary displacement around an axis longitudinal geometric axis 18. Thus, a surgeon can rotate the terminal effector 12 rotating the rotary handle 30. The tube closure 24 is also rotated by the rotation handle 30 but retains a degree of longitudinal displacement with respect to that to cause the closure of terminal effector 12. Within the frame 28, a firing pin 32 is positioned for movement longitudinally and is coupled between anvil 14 of terminal effector 12 and a trigger trigger 34 of multiple operations. The trigger of closure 26 is in distal position relative to a gun handle 36 of the handle 20, the firing trigger 34 being located at distal position with respect to gun handle 36 as well as closing trigger 26.

In an endoscopic operation, once the executing portion 22 is inserted into a patient to access a surgical site, a surgeon refers to a endoscopic device or other training device diagnostic images to place the tissue between the anvil 14 and the elongated channel 16. Grasping the closing trigger 26 and the handle of gun 36, the surgeon can repeatedly turn on and place the tissue. Once satisfied as to the location of the tissue with respect to terminal effector 12 and the amount of tissue On, the surgeon presses the trigger 26 completely towards the gun handle 36 turning on the existing fabric in the terminal effector 12 and closing the closing trigger 26 in this position on (closed). If you are not satisfied with this position, the surgeon can release the closure trigger 26 by pressing the release button 38 (Fig. 6), whose operation It is described in more detail below, and then repeated the process to turn on tissue.

If the pressure is correct, the surgeon can proceed with the firing of the surgical stapling instrument and cut 10, specifically, the surgeon grabs the trigger 34 and the gun handle 36, by pressing the firing trigger 34 a default number of times. The number of shooting operations necessary is determined ergonomically based on a maximum size hand in hand, a maximum amount of force that is going to be transmitted to the instrument during each firing operation, and the longitudinal and the required force that will be transferred to through the firing pin 32 to the terminal effector 12 during the Shooting. As will be seen in the exhibition offered below, certain surgeons may choose to graduate the trigger trigger in a different angular range of motion, to increase or reduce the number of firing operations in this way.

In Fig. 1, the release button 38 of the closure is hidden by a retraction lever 40 that would rotate distally over the top of the handle 20, leaving the discovered the release button 38 of the closure when the surgical stapling and cutting instrument 10 is being fired. After pressing the release button 38 of the closure for disconnecting a rotary transmission trigger mechanism 42 located inside the handle 20, the surgeon can pull the retraction lever 40 in the proximal direction to help the retraction of the firing pin 32 separating it from the terminal effector 12.

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Executing portion that includes a terminal effector with arm in AND

The advantages of the handle 20, capable of provide multiple operations shooting movements, has application in a plurality of instruments, said saying terminal effector 12 in Figs. 1 to 4. The terminal effector 12 responds to a closing movement from the handle 20 which is transferred longitudinally and distally by the tube of closure 24. Elongated channel 16 locks anvil 14 as a pivot to form opposite jaws, which are embedded in the frame 28 constituting a rigid fixation with the handle 20. The closure tube 24 locks the anvil 14 distally to the pivot connection between anvil 14 and elongated channel 16. Thus, a distal displacement of the closure tube 24 with respect to the frame 28 produces the closure and a proximal displacement with with respect to the frame 28 produces the opening of the terminal effector 12.

With particular reference to Fig. 4, the executing portion 22 also includes components that respond to a firing movement from the handle 20, specifically the firing pin 32 that couples a longitudinal movement between the firing mechanism 42 located in the handle 20 and the executing portion 22. In particular, the firing pin 32 (shown disassembled in Fig. 5) rotatably locks a member of through shot 36 located within a longitudinal recess 48 of the frame 28. The through trigger member 46 travels longitudinally inside the frame 28 in response direct to the longitudinal movement of the firing pin 32. A groove longitudinal 50 of the closure tube 24 is operatively coupled with the rotation handle 30 (not shown), also enabling longitudinal groove 50 that the rotation handle 30 locks the frame 28 at the level of a small longitudinal groove 52 located inside it to make the rotation. The length of the longitudinal groove 50 of the closure tube 24 is sufficient to enable relative longitudinal movement with the handle of rotation 30 to carry out the closing movements respectively.

The distal end of the passing member 46 of the frame is attached to a proximal end of the trigger rod 56 that travels with the frame 28 to distally project a arm in E 60 to inside the terminal effector 12. The effector terminal 12 includes a staple cartridge 62 that is driven by the arm in E 60 that causes the clips to be driven upward from the openings 64 of the cartridge staples 62 to contact the grooves 68 of forming the staples of the anvil 14 creating staples formed in the form of "B". With specific reference to Fig. 3, the body 86 of the cartridge the clips also include an open vertical slot 70 for the passage of a vertically oriented cutting surface arranged to along a distal end of the E 60 arm to cut tissue while it is being stapled.

The illustrative terminal effector 12 is described in more detail in five US patent applications pending with the current one and transferred to common mode: 1) "Surgical stapling instrument that has a mechanism of single lock to prevent shooting "[" SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING "], with serial number 10 / 441,424, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on June 20 of 2003; 2) "Surgical stapling instrument that has about separate differentiated trip and close systems " ["SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS "], with serial number 10 / 441,632, of Frederick E. Shelton, Mike Setser, Brian J. Hemmelgarn, requested on June 20, 2003; 3) "Surgical stapling instrument that has a closure of spent cartridges "[" SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT "], with the number of series 10 / 441,565, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on June 20, 2003; 4) "Instrument surgical stapling that has a trigger lock for an anvil not closed "[" SURGICAL STAPLING INSTRUMENT HAVING A FIRING LOCKOUT FOR AN UNCLOSED ANVIL "], with the serial number 10 / 441,580, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on June 20, 2003; and 5) "Instrument surgical stapling incorporating a firing mechanism with E-arm "[" SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM "], with the serial number 10 / 443,617, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on June 20, 2003.

It should be noted that, although this memory is illustrated a non-articulated shaft 18, the applications of the present invention may include instruments susceptible to articulation, such as those described in the five US Patent applications transferred to common mode: 1) "Surgical instrument incorporating a mechanism of joint that presents a rotation around the axis longitudinal "[" SURGICAL INSTRUMENT INCORPORATING AN ARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS "] with serial number 10 / 615,973, by Frederick E. Shelton, Brian J. Hemmelgarn, Jeff Swayze, Kenneth S. Wales, requested on July 9, 2003; 2) "Stapling instrument surgical that incorporates a joint of a track for a trigger rod "[" SURGICAL STPALING INSTRUMENT INCORPORATING AN ARTICULATION JOINT FOR A FIRING BAR TRACK "], with serial number 10 / 615,962, by Brian J. Hemmelgarn, requested on July 9, 2003; 3) "Surgical instrument with a mobile displacement joint control "[" SURGICAL INSTRUMENT WITH A LATERAL-MOVING ARTICULATION CONTROL "], with serial number 10 / 615,972, by Jeff Swayze, requested on July 9, 2003; 4) "Stapling instrument surgical that incorporates a tapered trigger rod for get increased flexibility around the board of joint "[" SURGICAL STPALING INSTRUMENT INCORPORATING A TAPERED FIRING BAR FOR INCREASED FLEXIBILITY AROUND THE ARTICULATION JOIN "], with serial number 10 / 615,974, by Frederick E. Shelton, Mike Setser, Bruce Weisenburgh, requested on July 9,  2003; and 5) "Surgical stapling instrument that incorporates articulation joint support plates to support a firing pin "[" SURGICAL STAPLING INSTRUMENT HAVING ARTICULATION JOINT SUPPORT PLATES FOR SUPPORTING A FIRING BAR "], with the Serial number 10 / 615,971, by Jeff Swayze, Joseph Charles Hueil, requested on July 9, 2003.

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Multi Operations Trigger Handle

In Figs. 5 to 8, the handle 20 responds to the closing trigger 26 and trigger 34 actuation to generate respectively the closing and firing movements on the executing portion 22. With respect to the movement of closure, closure trigger 26 includes an upper portion 76 that includes three side openings, a pin hole 78 located in front position, a rear pin hole 80 located in lower position, and a central drain 82. Three stems oriented laterally between and locked by a half plates right and left 84, 86 of the handle housing 88 (showing the right half plate 84 in Figs. 5 and 6 and showing the average curved plate 86 in Fig. 7). In particular, a rear stem 90 it passes through the rear pivot hole 84 of the upper portion 80 of the closing trigger 26, and thus the closing trigger 26 pivots around the rear rod 90, and an upper rod 94 which is above the front rod 92, crosses the central drain 86, which is shaped to constrain the movement of the closing trigger 26 by contacting the front stems and upper 92, 94 at each end of the trigger movement. Thus, the central drain 86 includes a vertical portion, whose lower surface contacts the front rod 92 when the lock trigger 26 are in the forward (distal) position, and includes an upper portion, inclined in the proximal direction, whose upper and front surfaces contact the upper stem 94 respectively when the closing trigger 26 is in its relaxed, forward position, and in its driven position, proximal

A closing anvil 96, which locks the tube of closure 24 slides longitudinally inside the housing 92 of the handle and is locked at its end distal by a proximal end of the closure tube 24, transferring thus the longitudinal closing movement to the closing tube 24 and with this to the anvil 14 to close the terminal effector 12. This lock enables rotation of the closure tube 24 while the anvil Closing 96 not broken. Above this lock, a hole of side pin 100 is coupled to a tie rod 102 by a front pin 104, the other end of the tie rod being closure 102 coupled to pin hole 82 of the trigger closure 26 by means of a rear pin 106.

A triangular separator 120 includes about holes 122 to 126 to receive stems 90 to 94 and is located to the left of the central portion 80 of the closing trigger 26. A the left of the triangular separator 120, a cam disc 130 Rotationally receives the front stem 92 and includes a slot semicircular 132 that receives the rear and upper stems 90, 94. A central hole 134 receives the central pin 92. On the left from cam disc 130 a rod hole 136 located in a upper end 138 of firing trigger 34 receives the stem upper 94. A distally open recess 140 located on the trigger firing below the hole of the rod 36 is aligned to receive the front rod 92, enabling the trigger to shot 34 is dragged distally during shooting. The friction lock down cam cam 102 (see the Fig. 8) with trigger trigger 34 during actuation of the shut-off trigger 26 causes trigger trigger 34 to be partially dragged in the distal direction, placing the trigger of shot 34 in grip position.

With specific reference to Figs. 5, 9, and 10, cam disc 130 has a series of cam lobes 142 to 144 (Fig. 9) around the front portion (when in its un-triggered state, as shown), specifically along on its left side, which are respectively locked by the firing trigger 34 to transmit a top-to-front rotation to the cam disc 130. This rotation is transferred by a gear train 150
(Fig. 10) of the rotary transmission trigger mechanism 42, starting with a gear portion 152 located around a lower portion of the right side of the cam disc 120 that engages with a small insane gear 154, which thus rotates from above towards the rear at an increased speed with respect to cam disk 130. A large crazy gear 156 is connected by a crazy shaft 158 to the small crazy gear 154 and thus rotates in the same direction and speed. A second small gear 160 is geared to the major idler gear 156, and is thus rotated from the top towards the front at a higher speed. A large fine tooth gear 162 is connected by a second shaft 164 to a second small gear 160 and thus rotates in the same direction and speed as the second small gear 160. The gear train 150 thus simplifies the movement of the disc of cam by including a dual gear double gear ratio feature to provide additional longitudinal firing motion. The large fine tooth gear 162 engages with a gear segment 168 located on a lower side of a solid rack 170 whose distal end meshes with the proximal end of the firing pin 32. The rack 170 has its distal portion longitudinally slidably housed within the closure anvil 96 and its proximal portion longitudinally slidably housed between half right and left curved plates 84, 86 of the handle housing 88.

The selective lock trigger 34 with cam lobes 142 to 144 provides a displacement additional longitudinal enabling multiple operations of trigger trigger trip 34. To prepare the train for gears 150 for shooting, cam disc 130 is pressed towards its position not triggered by a retraction spring 172 of the gear train fixed to an integral pin 174 which projects to the left formed within an annular recess 176 at a lower proximal edge of cam disc 120 (Figs. 9 and 10). The retraction spring 172 of the gear train has its end fixed to an integral pin 178 with the housing 88 of the handle.

With specific reference to Figs. 5, 9, 11, below and distally with respect to the upper end 128 of the trigger trigger 34 is a pin hole 180 of the drive wedge. A drive wedge 182 is attached against the left side of the trigger 34 by means of a pin 184 of the drive wedge, among which is located a separation finger 186 that contacts a surface circular without cam, central, of cam disc 120. A spring type of torsion 188 located between the separation finger 186 directed towards up and in the proximal direction and drive wedge 182 directed downward and proximally forces the wedge of drive 182 up to lock cam lobes 142 to 144.

Below the pin hole 180 of the wedge of drive, the drive wedge 182 also has a 190 lower and proximal pin hole and trigger trigger 34 includes a bottom pin hole 192. A tension spring opposite 194 is fixed between a pin that extends towards the right 196 located in the bottom pin hole 192 and the pin hole 190 to force the wedge down drive 182, thus preventing the wedge of drive 182 rotate too far up when the trigger 34 is cyclically graduated distally between firing operations (see Fig. 10 which has the trigger shooting 34 hidden).

With specific reference to Fig. 12, when drive wedge 182 is dragged away from one of the cam lobes 142 to 144 between firing operations, the disk of cam 130 would tend to rotate towards the rear by the action of retraction spring 172 of the gear train if not for the action of an anti-reverse lever 200. The side pins 202, 204 of the backstop pendulum lock respectively the half right and left curved plates 84, 86 of housing 88 of the hilt Above the pins 202, 204, a spring of backstop voltage 206 is fixed to an integral pin 208 of the right half curved plate 88 distal to the backstop pendulum 200. With specific reference to Fig. 5, a lower foot 210 of the backstop pendulum 200 effects friction contact with a bottom surface 212 of solid 170 rack. When the foot bottom 210 of the backstop 200 is dragged in proximal direction by means of a solid retraction zipper 170, the anti-reverse lever 20 comes to perform a lock perpendicular with the solid 170 rack that increases strength of friction, blocking the solid zipper 170, which is enough to overcome the traction force backwards supplied by the retraction spring 172 of the train gears When the solid zipper 170 is pulled in distal direction by trigger trigger 34, lower foot 210 it is pushed distally, reducing friction and enabling shooting. The crazy shaft 158 and the pressure coming of the backstop tension spring 206 prevent excessive forward movement of the lower foot 210.

In Fig. 12, the release button 38 is pivoted upward around its rear pivot axes 220, 222, raising his distal arm 224 above the directed arm approximately 226 of the backstop pendulum 200 enabling the distal displacement of the lower foot 210 to block the rack 170 between firing operations. A locking lever 230 of the clamp swings around its pivot pins 232, 234 to carry out this lifting of the release button 38. In particular, an arm 236 projecting in the proximal direction and upwards of the locking lever 230 of the clamp rests slidably on a lower surface of the distal arm 224 of the release button 38. A locking arm 238 which is projects distally of the locking lever 230 of the clamp locks the closure anvil 96 in its locked position. In particular, a lug 240 extends downward between the arm 236 projecting in the proximal and upward direction and the locking arm 238 projecting distally is pressed proximally by a tension spring 232 which is also fixed to the right half curved plate 84 of the handle housing 88 by means of a pin 244. With reference to Figs. 6 and 7, the locking arm 238 that distally projecting rests on a step 246 located on an upper proximal portion of the closure anvil 96 enabling the closure anvil 96 to be displaced in distal direction to transfer the closing movement. A notch 248 locking of the clamp located distally and towards up in an open recess of step 246 receives the arm of lock 238 that projects distally when the anvil of closure 96 reaches its distal driven position (Figs. 8, 9). So, the surgeon can release the closing trigger 26 while remaining subject the terminal effector 12.

With reference to Figs. 5 to 8, 12, in addition to the anti-reverse feature described above and of the fastening feature of the closure, a trigger lock feature by a lever 250 of trigger lock. With the surgical stapling instrument and close 10 in its initial open position and in the non-triggered state, the trigger lock lever 250 responds to the retraction of the closing anvil 96 by blocking the displacement of distal shot of the solid 170 zipper as shown in concrete in Figs. 7 and 8. The trigger lock lever 250 includes an arm 252 that extends distally that has an upper surface 254 located distally on a ramp that is aligned with right edge 256 along the proximal portion of the solid zipper. A right edge lowered 258 along of the remaining distal portion of the solid zipper 170 enables that the upper surface 254 distally formed in ramp of trigger lock lever 250 rotate upwards, pivoting around its proximal side pins 260, 262 forced by a tension spring 264 connected to a vertical lug 266 which is fixed perpendicularly and proximally to arm 252 that is extends distally The other end of the tension spring 264 is connected to an integral pin 268 constituted in the half right curved plate 84 of the handle housing 88 behind the vertical lug 266.

As shown in Fig. 8 surface 254 Configured distally on ramp blocks distal displacement of the solid zipper 170 being footwear upwards by a step 270 constituted transversely to the proximal end of the closure anvil 96, open proximally and upward to receive arm 252 that extends distally and that Tilt down the trigger lock lever 250. With the closing anvil 96 displaced distally to close the effector terminal 12 as shown in Fig. 2, the right edge 256 of solid zipper 270 can pass over surface 254 configured distally on the ramp that responds to that step moving arm 252 extending distally towards down to lock a lower step 272 constituted in the anvil of closing 96 in the direction proximal to the highest step and more distal 270. The lock lever 250 of the trigger lock with the lower step 272 offers the advantage of preventing retraction (proximal displacement) of the closure anvil 96 until the 170 solid zipper be retracted. Thus, the initial retraction of the trigger mechanism 42 advantageously occurs before the release of terminal effector 12, which would otherwise cause the jamming of the firing mechanism 42. Likewise, it can there is sufficient friction contact between the step bottom 272 and the trigger lock lever 250 for advantageously require a two stage procedure to do return the surgical stapling instrument 10 to its state Open and retracted. In particular, once the mechanism of shot 42 has been retracted by pressing release button 38, a slight pressure on trigger 26 would tend to enable the trigger lock lever 250 to rise to its trigger lock position. Then the release of the closing trigger 26 can continue with the lever 250 trigger lock aligned for step lock more high 270 when closing anvil 96 is fully retracted and therefore the terminal effector 12 is open.

It should also be noted that zipper 170 it may advantageously be constituted by braces that enable a proximal portion of the firing mechanism 42 is curved inside the handle, allowing a more design compact. Said articulated zipper is described in greater detail. in the shared ownership patent "Stapling instrument surgical that incorporates a firing mechanism that has a articulated rack drive "[" SURGICAL STAPLING INSTRUMENT INCORPORATING A FIRING MECHANISM HAVING A LINKED RACK TRANSMISSION "], with serial number 10 / 673,930 by Jeffrey S. Swayze, Frederick E. Shelton IV, requested on September 29, 2003

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Irregular Shooting Operations

The fact that the trigger trigger 34 interact with a rotary transmission trigger mechanism 150 upstream of the solid 170 rack offers an opportunity to further enhance multiple firing operations. With reference to Fig. 13, a cam disc 330 facilitates some irregular firing operations so that it can be increased the mechanical advantage of specific firing operations that they are expected to face increased resistance with others operations that have a minor mechanical advantage to reduce the number of firing operations required. Likewise, the return touch provided to the surgeon is more uniform, avoiding a misperception that a blockage has occurred or when a total displacement has been obtained when an operation requires a firing force greater than that required by an operation preceding.

The trigger 34 by means of a operational relationship with drive wedge 182, interacts with three cam lobes 342 to 344 around a different center of rotation than cam disc 330 which includes cam lobes; in this way, enhanced control of how the cam disc 330 rotated by trigger actuation shot 34. The separation of the cam lobes 342 to 344, their depth (as shown by its radial distances respective R1-R3 with respect to the front pin 92), and its global configuration allow the desired variation of the distance of operations and a mechanical advantage.

As shown in Figs. 14 and 15, the Force requirements for firing vary as a function of longitudinal trip displacement with respect to changes in load. In Fig. 14, the firing distance It has been divided into three shooting operations of equal distance. During a first operation, the force appears as a curve that amounts during a first portion of the operation and to continuation is relatively constant with a slight increase. During the second operation and entering the third operation, this slight increase in the required force continues, followed by a fall when the displacement of total shot. These changes of the required force are related to several factors, such as the amount of tissue that is being cut, the staples that are being cut driven, and mechanical friction found in the mechanism of shot 150 and in the executing portion 22. The surgeon experiences the highest level of work developed (that is, the force to along a distance) during the second operation, as soon as that Area2 is larger than the adjacent Area1 and that Area3. If the amount of force required is too high for surgeons in issue, then additional operations may be required to this rotary transmission trigger mechanism 150 trigger irregular.

In Fig. 15, shooting operations irregular are used to advantageously modify the quantity  longitudinal trip displacement between operations, such as is shown at the end of the first operation in reference D * 1, which is more than the D1 of Fig. 14, and the second operation in the reference D * 2, which is smaller than the D2 of Fig. 14. The amount of work required by the surgeon during each operation  is roughly the same, which would tend to avoid excess strength in the hand by some surgeons. Also, the surgeon is less exposed to misinterpret the return touch provided by the surgeon with medium strength to shoot, looking like every operation more constant. In particular, although it is not shown, it should be appreciated that having a shorter longitudinal displacement during operation 2 means that an increased mechanical advantage has been used to reduce the instantaneous force to shoot perceived on the trigger Shooting

An illustrative mechanism of rotary transmission shot 42 as a mechanism that benefits of an irregular firing operation to maximize the displacement relative to the required force, however, It should be noted that a proposal for a linearly coupled mechanism to turn the trigger trigger movement into a longitudinal firing movement can also benefit from regular firing mechanism. In Fig. 16, a straight zipper 400 presenting sections 402, 404, 406 of the zipper teeth separated irregularly, specifically, in a distal section 402 of the teeth of the zipper the three feet shown have a longitudinal extension narrow. In a middle section 404 of the zipper teeth, the three teeth shown have a longitudinal extension moderate In a proximal section 406 of the teeth of the zipper, the three teeth shown have an extension extended longitudinal. Thus, a 408 tongue forced forward and down from a pivot connection 410 to a portion upper 412 of a trigger trigger 414 tends to engage with a tooth determined at a later time in the operation of shot on contact with the teeth located in the direction proximal 406 of the teeth of the zipper than in the section distal 402 of the teeth of the zipper. The mechanical advantage and the degree to which the surgeon's hand has been grasped when the Linguete 408 locks the straight zipper 400 varies thus depending on the length of the zipper teeth for each section 402, 404, 406.

In Fig. 17, an application of some irregular firing operations on a 430 firing mechanism articulated zipper, such as the one described with greater detail in the pending US patent application with the current transferred to common mode with serial number 10 / 673,930, entitled "Surgical stapling instrument that incorporates a trigger mechanism that has a zipper transmission articulated "[" SURGICAL STPALING INSTRUMENT INCORPORATING A FIRING MECHANISM HAVING A LINKED RACK TRANSMISSION "], by Jeffrey S. Swayze and Frederick E. Shelton IV. In this case, the length of the Ramp groove 432, 434, 436 varies on the three braces 438, 440, 442 constituting an articulated rack 444.

In Fig. 18, a locking device for 500 counterport incorporates irregular firing operations with a tapered firing pin that is locked by a 504 leg plate claw style lock on the door that is forced down and forward around a pivot connection 506 located in a 508 upper portion of a 510 trigger trigger. The leg plate claw 504 has an arm 512 that projects distally which connects the pivot connection 506 with a downward arm 514 which includes an opening 516 to receive a tapered hammer 502. When the upper portion 508 of the trigger 510 is displaced distally to shoot, the arm that Project 512 travels distally. The contact of friction of the tapered hammer 502 to the opening 516 causes the arm down 514 rotate up and forward the 504 plate of the claw leg of the door, causing the opening 516 no longer slides along tapered firing pin 502 but instead hold and lock, forcing the firing pin tapered 502 to fire the instrument distally. He tapered firing pin 502 dictates thus to what extent the leg plate of claw 504 must rotate up and forward before it produce the connection.

Thus, in each of these versions of Figs. 16 to 18 of a tongue-type gear of a trigger trigger with a straight portion of the trigger zipper, the changing tooth separation results in operations of irregular firing and avoids the situation in which the mechanism of shot lock the trigger trigger in position closest to your maximum relaxed position when superior strength is required. In instead, the delay of the lock until the trigger trigger has been located closer to the gun handle of the instrument ensures that the amount of work (strength in relation to distance) inverted during the trigger operation provided It can be comparable to other shooting operations. Likewise, the force can be exerted with the trigger trigger closest to the pistol handle when a force is generically available greater hand. Likewise, the relative arched displacement of the upper portion of the trigger trigger with respect to the longitudinal distal displacement of the zipper also varies in  based on when the tongue locks the zipper.

In use, the surgeon places the terminal effector 12 and axis 18 through the cannula of a trocar up to a surgical site, locates anvil 14 and lengthens channel 16 with the opposite jaws to predate the tissue that is going to be stapled and cut. Once satisfied with the position of the effector terminal 12, the trigger trigger 26 is fully pulled towards the gun handle 36 of the handle 20, causing a closure strap 102 advance a closure anvil 96 and with this a closing tube 24 to close the terminal effector 12. The closure anvil 96 displaced distally presents a notch 248 for locking the clamp receiving a lever 230 of fastening lock, which holds the terminal effector 12. The Repeated pressing of the trigger trigger 34 triggers the firing pin 32 sequentially locking a drive wedge 182 which is coupled to the trigger 34 and the lobes of cam 342 to 344 located on cam disc 330. This rotation of ratchet is transferred by the firing mechanism of rotary transmission 150 to advance distally the solid zipper 170. With the advanced closing yoke 96, the rack 170 is able to depress a lever 250 for locking the shot by removing it from the step. Between firing operations, the 100 backstop pendulum is dragged into a perpendicular locking contact with zipper 170 making against a retraction force transmitted by the spring of retraction 172 of the gear train connected to the gear cam 330. Once the trip offset has been achieved complete, the release of the release button 38 first releases the 100 backstop pendulum, allowing the zipper solid 170 retracts and, secondly, releases lever 230 from locking of the fastener relative to the closing yoke 96 to eliminate an impediment that opens the terminal effector 12. The surgeon squeezes the closing yoke 26 to enable the locking lever 250 of the shot release from the closing yoke 96 and release the trigger from closure 26, allowing the closing yoke 96 to move in proximal direction where it holds the lever 250 for locking the shot to block the solid zipper 170 and enabling the Shooting. Then the executing portion 22 of the instrument surgical stapling and cutting 10 can be removed, for example, replacing the cartridge 62 of the staples to prepare another operation.

Although the present invention has been illustrated by describing various embodiments and although illustrative embodiments have been described in a considerably detailed form, it is not the intention of the applicant restricting or in any way limiting the scope of the claims attached to said detailed expression. The subject matter experts can easily warn of the existence of advantages and additional modifications.

It should be noted that the terms "proximal" and "distal" are used herein with reference to a practitioner who grabs an instrument handle. Thus, the terminal effector 12 is distal with respect to the most proximal handle 20. It should also be appreciated that, for reasons of comfort and clarity, spatial terms such as "vertical" and "horizontal" are used herein memory in relation to the drawings. However, the instruments Surgical are used in many orientations and positions, and These terms are not intended to be limiting and absolute.

The present invention is being exposed in terms of procedures and endoscopic devices. However the use herein of terms such as "endoscopic" should not be construed to limit this invention to a surgical stapling and cutting instrument for use only in conjunction with an endoscopic tube (that is, a barter). On the contrary, it is considered that the present invention you can find employment in any procedure in which the access is limited to a small incision, including but not limited to laparoscopic procedures, as well as to open procedures

For example, although here describes a surgical stapling and cutting instrument 10 that advantageously it has a separate and independent drive from the closing and firing, however it provides flexibility from the clinical point of view However, it should be appreciated that applications in accordance with the present invention must include a handle that converts a single user drive into a Only trigger movement that closes and triggers the instrument.

Likewise, although a handle is illustrated manually operated, a motorized or energized handle of any other way can get benefits from the incorporation of an articulated zipper in accordance with what is described herein memory, making it possible to reduce the size of the handle or other advantages For example, although it is convenient to partially collect the articulated zipper inside the gun handle, must it can be appreciated that the pivot connection between braces allows the collection of the strap parallel to the straight portion defined by the shaft and cylindrical body of the handle.

Claims (9)

1. A surgical stapling instrument (10) and court comprising:

an effector terminal (12) operatively configured to respond to a firing motion;

a shaft (18) fixed to the terminal effector (12) and that includes a trigger member elongated (32) coupled to the terminal effector (12) so that the displacement transmit the firing movement longitudinally; Y

a hilt (20) fixed proximally to the axis (18), which understands:

a member of cam (330) that includes a plurality of cam lobes (342, 343, 344);

an actuator of shot (34) repeatedly removable in one direction of shooting and in a return address, and operatively configured to interact with a respective cam lobe (342, 343, 344) during each trigger operation;

a mechanism of Shooting; Y

a mechanism backstop (200) operatively configured to prevent lar retraction of the firing member (32) between the operations of trigger actuator trip (34);

in which

at least one of The cam lobes (342, 343, 344) differ in the form of a adjacent cam lobe and trigger mechanism responds to intermittent movement of cam member (330) to produce the longitudinal firing motion on the firing member (32)

2. The surgical instrument (10) of the claim 1, wherein the cam member comprises a disc of  cam (330) that includes a plurality of cam lobes (342, 343, 344) about at least a portion of a circle. 3. The surgical instrument (10) of the claim 2, wherein the handle (20) also comprises a wedge (182) coupled to the trigger actuator (34) and configured operatively to sequentially lock a respective lobe of the plurality of cam lobes (342, 343, 344) of the cam disc (330) during each movement of the trigger actuator (34) in the shooting direction. 4. The surgical instrument (10) of the claim 2, wherein the handle (20) also comprises a rack (170) connected to the firing member (32) of the shaft (18) and coupled by a gear connection with the disk cam (330) to transmit an intermittent rotation of the disk of cam (330) as longitudinal firing movement. 5. The surgical instrument (10) of the claim 4, wherein the zipper (170) is coupled by means of a gear connection with the cam disc (330) Composed of a gear train. 6. The surgical instrument (10) of the claim 5, wherein the gear train comprises a gearbox assembly that creates intermittent rotation of the cam disc (330) on increased longitudinal movement of the zipper (170). 7. The surgical instrument (10) of the claim 6, which also comprises a mechanism (250) of trigger lock that responds to a non-closing mechanism closed to prevent the movement of the rack (170). 8. The surgical instrument (10) of the claim 7, wherein the locking mechanism (250) of the trigger is operatively set to respond to the zipper (170) that has been at least partly shot to block the opening movement of the closing mechanism. 9. The surgical instrument (10) of a any of the preceding claims, wherein the effector  terminal (12) comprises a pair of opposite jaws (14, 16) that respond to a closing movement and a trigger rod that responds to the trigger member (32), the axis (18) being configured operationally to transmit the closing movement through a closing member (24) to the terminal effector (12), the handle (20) also comprises a closing mechanism (26) operationally configured to produce the movement of closing.